彩色多普勒超声对精索静脉曲张术后生育力指数变化的预测价值

摘要

目的 探讨精索静脉曲张的彩色多普勒超声分级对术后患者生育力指数变化的预测.方法 选择151例经彩色多普勒超声诊断并分级的精索静脉曲张患者,分析蔓状静脉的最大内径与反流程度之间的关系,并以蔓状静脉反流程度和最大内径进行分组,对比分析各组精索静脉高位结扎术前后生育力指数的变化.结果 蔓状静脉最大内径>1.5 mm时即可检出病理性反流,蔓状静脉内径大小与反流程度呈正相关(r=0.89).Ⅰ级反流组的手术前后生育力指数差异无统计学意义(P>0.05),Ⅱ级、Ⅲ级反流组的手术前后生育力指数差异具有显著统计学意义(P<0.01).蔓状静脉内径≤2.0 mm的患者术后生育力指数差异无统计学意义(P>0.05),内径2.1～3.0 mm的术后生育力指数差异具有统计学意义(0.013.0 mm组的术后生育力指数差异具有湿著统计学意义(P<0.01).结论 精索静脉曲张的彩色多普勒超声分级能够预测患者术后精液质量的变化,蔓状静脉内径≤2.0 mm的或仪在Valsalva试验时蔓状静脉出现病理性反流的精索静脉曲张患者不必要进行手术治疗.%Objective To discuss color Doppler uhrasonographic (CDU) grading of varicocele (VC) in predicting the changes of the fertility index (FI) after varicocelectomy.Methods One hundred and fifty-one patients with VC were diagnosed and graded by CDU.All patients were grouped by the regurgitant volume and the maximum diameter of pampiniform plexus veins(PPV).The relation between the regurgitant volume and the maximum diameter of PPV and the changes of the FI after varicocelectomy was analyzed.Results The pathological regurgitation could be detected when the PPV diameter > 1.5 mm.The positive correlation was observed between the regurgitant volume and the diameter of PPV (r = 0.89, P <0.01).The pre- and postoperative FIs were extremely significant difference in regurgitation grade Ⅱ and regurgitation grade Ⅲ (P < 0.01) but not significant difference in regurgitation grade Ⅰ (P>0.05).The pre- and postoperative FIs were no significant difference in the group with the PPV diameter ≤ 2.0 mm (P > 0.05), but statistically significant difference in the groups with the diameters 2.1-2.5 mm and 2.6-3.0 mm (0.01 < P <0.05).FIs in the group with the diameter > 3.0 mm exhibited extremely significant difference after varicocelectomy (P < 0.01).Conclusions CDU grading of VC could be used to predict the changes of seminal quality after varicocelectomy.Varicocelectomy isn't necessary to the patients with VC that the PPV diameter ≤ 2.0 mm or pathological regurgitation being detected only on Valsalva maneuver.